MEDICARE: FERESHTEH JAHANPANAH A PROFESSIONAL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G65104	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609194570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERESHTEH JAHANPANAH A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1333 E MAIN ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-6540
Country	:	US
Telephone Number	:	619-447-6001
Fax Number	:	619-447-6096

Provider Business Practice Location Address
First Line	:	1333 E MAIN ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-6540
Country	:	US
Telephone Number	:	619-447-6001
Fax Number	:	619-447-6096

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. FERESHTEH JAHANPANAH
Credential	:	M.D.
Telephone Number	:	619-447-6001

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	10/19/2015

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